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Slow disappearance of peripheral blast cells: an independent risk factor
indicating poor prognosis in children with acute lymphoblastic leukemia
J Rautonen, L Hovi and MA Siimes
Children's Hospital, University of Helsinki, Finland.
The aim of this study was to find out whether the time required for
disappearance of peripheral blast cells, or blast clearance, could be used
to identify patients with a slow response to treatment associated with a
poor prognosis of acute lymphoblastic leukemia (ALL). Our series consisted
of 158 children with newly diagnosed ALL. The mean follow-up time was 69
months (range 22 to 140 months). Blast clearance was significantly
associated with length of event-free survival. Only two of nine children
with blast clearance greater than or equal to 2 weeks and 4 of 11 children
with blast clearance of 11 to 13 days were in remission at the time of
analysis as compared with 86 of 138 of the children with more rapid blast
clearance. The respective 5-year event- free survivals were 17%, 36%, and
60% (P = .003). Multivariate analysis showed that the relative risk of
death or relapse in patients with blast clearance of greater than 10 days
was 5.2-fold (95% confidence limits 2.1 to 13.1) as compared with the
others (P less than .001). Our results indicate that patients with a slow
response to treatment can be identified by simple differential peripheral
cell counts during the early induction phase well before or even instead of
performance of a more invasive bone marrow aspiration.
Volume 71,
Issue 4,
pp. 989-991,
04/01/1988
Copyright © 1988 by The American Society of Hematology
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